CORRELATION OF THE 
PHYSICIAN AND THE 
LAYMAN. 




ADDRESS OF THE PRESIDENT. 


-BY- 

WILLIAM FRANCIS DREWRY, M. D., 
Petersburg, Va. 


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Correlation of the Physician 
and the Layman. 


Address of the President. 


BY 

WILLIAM FRANCIS DREWRY, M. D., 

M 

Petersburg, Va. 


* 


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•V OF 0. 

IAN 19 1S09 | 







CORRELATION OF THE PHYSICIAN 
AND THE LAYMAN. 


ADDRESS OF THE PRESIDENT.* 

By WILLIAM FRANCIS DREWRY, M. D., 
Petersburg, Ya. 

Superintendent Central (Virginia) State Hospital, etc 


Fellow members of the Medical Society of 
Virginia, ladies and gentlemen: 

“No man/’ says Carlyle, “is born without 
ambitious worldly desires.” To be the official 
head of this Society is surely a . most laud¬ 
able aspiration. Conscious, however, of my un- 
worthiness and of my inability to measure up 
to the standard of my predecessors, it was with 
painful misgivings that I assumed the duties 
and responsibilities of this high office. But, 
one thought reconciles me, and that is this: 
The same generosity that prompted my col¬ 
leagues to thrust this greatness upon me, will 
perhaps induce them to “pass my imperfections 
by.” Psychology teaches us that it is most 
difficult to give expression to our deepest emo¬ 
tions. Therefore, gentlemen, I acknowledge, 
in stereotype phrase, but with profound grati¬ 
tude, your expression of confidence and partial- 
ity. 

A British historian once said: “Before you 
attempt to write on any subject, be quite cer- 


♦Delivered before the Medical Society of Virginia 

during the Thirty-ninth Annual Session, held at Rich¬ 
mond, Va., October 20-23, 1908. 



4 


tain that you can say something fresh about it. ,y 

As. there is nothing original in me but origi¬ 
nal sin, I dare not hope to tell you anything 
new. The field has been so well harvested 
that there is little left even for a gleaner. 

Having made my confession, I shall make 
some discursive remarks on The Correlation 
of the Physician and the Layman . 

RECENT ADVANCES IN MEDICINE AND SURGERY. 

It is pertinent to insert in this address to 
the profession and the public some of the more 
important recent advances in medicine and sur¬ 
gery. 

The past thirty years has been the most act¬ 
ive period in the acquisition of medical knowl¬ 
edge and medical art. It marks the transform¬ 
ation from the old to the new. It is character¬ 
ized by the most fruitful endeavor and the most 
brilliant achievements which have yet been 
added to the imperishable chronicles of the 
profession of medicine. 

The discovery and the development of the 
bacterial, or germ, origin of disease, and the 
application of the newly acquired knowledge, 
have revolutionized the practice of medicine 
along many important channels. Between the 
pathologist and the clinician a closer alliance 
has been formed, resulting in giving new in¬ 
sight into disease processes. The results of 
research conducted in laboratories have brought 
about a more definite solution of difficult prob- 


5 


lems in place of conjecture, as to the origin 
and spread of infectious diseases, as exempli¬ 
fied especially in the prevention of tubercu¬ 
losis, cholera, malaria, yellow fever, plague and 
other diseases. 

Dr. Clouston did not overstate tbe case when 
he said: “The sensational triumphs of modern 
surgery which Lister ,has brought about by a 
study of the microbic enemies of mankind, the 
good effects of anti-serums and the abolition 
of malaria by killing mosquitoes, are often 
looked on as miraculous tales of the supernat¬ 
ural rather than as the results of scientific 
study.” 

In tbe past few years, to chloroform and 
ether have been added local, spinal, and other 
anesthetics to further illuminate the horizon of 
surgery and to enlarge the scope of its already 
splendid accomplishments. Among other special 
advances in surgery, may be mentioned the ap¬ 
plication of anti-sepsis and asepsis; the opsonic 
diagnosis and treatment; improved operative 
technique in the management of intra-perito- 
neal diseases generally and in the digestive 
tract especially; radical surgery of malignant 
growths and of the brain and nervous system; 
development and progress in operative gyne¬ 
cology ; direct transfusion of blood by the anas¬ 
tomosis of arteries,, and suturing blood-vessels, 
meaning the possibility of exchange of organs. 
The X-rays and various other electrical appli- 


G 

ances for diagnostic and therapeutic purposes 
in both surgery and medicine have cleared our 
pathway to the solution of many perplexing 
problems. 

The transformation that has taken place in 
hospitals of every character indicates an up¬ 
ward tendency. The crude methods of not 
many years ago have given away, in the evo¬ 
lution of these institutions, to means of 
investigation, more accurate diagnosis and new 
appliances for proper and scientific treatment. 
These, with the humane and skillful care of 
the sick and injured and infirm, have prac¬ 
tically destroyed public prejudice and inspired 
confidence. 

The exigencies of the times have lead to bet¬ 
ter equipped men for general practice and sur¬ 
gery, as well as for the specialties. Better 
academic preparation than formerly is now re¬ 
quired, of the medical matriculate. More em¬ 
phasis is being put upon the importance of 
clinical training at the bed-side and in surgi¬ 
cal demonstration. . A more extended and thor¬ 
ough medical curriculum is required, and fin¬ 
ally, a. test of qualification is made by a state 
medical examining board. Notwithstanding 
this advance in the past twenty years, we have 
not yet reached that desired high standard in 
either the academic requirements or the med¬ 
ical qualifications for which the better element 


7 


in the profession and the higher class medical 
school are striving. But this is forthcoming. 

Viewed from the vantage ground of present 
achievement, greater things may be expected 
in the years to come. I am not in accord, how¬ 
ever, with that charming optimism which holds 
out for the future the possibility of the ulti¬ 
mate extinction of disease and a prolonged ten¬ 
ure of human existence. As long as vicious 
heredity, untoward environment, ignorance, 
weak and perverted wills exist, disease, infirm¬ 
ity and death, will cast their shadows over the 
pathway of mankind; and just as surely will 
the end come from sheer old age, which, like 
a “lowr-burning flame, flickers and finally goes 
out.” 


THE FORWARD MOVEMENT. 

To preserve health and to prevent disease 
are the objects of the great modem science and 
art of preventive medicine, which is the high¬ 
est development of our science. A wider knowl¬ 
edge and a more exact application of prophy¬ 
laxis have become to be recognized as probably 
the most important features of medicine, sur¬ 
gery, obstetrics and sanitary science. The re¬ 
sults have been seen in the improvement of the 
health of the people, lessening the suffering of 
the living, saving lives and increasing human 
happiness.’ There is witnessed everywhere a 
general awakejning, which is crystalizing in 


6 


efficient organized efforts, under governmental 
direction and control. 

This great movement to combat the enemies 
to health consists in efforts to bring about nor¬ 
mal living conditions, improve the family and 
home life, reform and improve the methods of 
teaching and training children, secure adequate 
sanitary protection, prevent premature deaths, 
insure inspection and control of all sources of 
public water supply, provide proper disposal 
of sewerage, maintain, wherever needed, 
efficient quarantine regulations, enact and en¬ 
force laws regarding pure food and drugs, es¬ 
tablish a general system of vital statistics, etc. 

In order to make the efforts of the boards 
of health, commissioners and other custodians 
of the people’s health, effective, public opinion 
must be aroused to an intelligent apprecia¬ 
tion of the value of preventive measures in 
the most comprehensive sense. The govern¬ 
ment, in which lies the power to make laws and 
enforce proper protection to its citizens, has no 
higher duty than that of safeguarding their 
health. To do this, ample means is the first 
prerequisite. The next is the employment of 
well-equipped, thoroughly trained and conscien¬ 
tious public health officials. Means should be 
provided for the establishment^ sanitoria for 
the tuberculous, and laboratories * for research 
and study into the causes, origin and prevention 
of various diseases, such as malaria, typhoid 


9 


fever, tuberculosis, pneumonia, dysentery, epi- 
lepsy, insanity, cancer, etc. 

Under the leadership of men, with brave spir¬ 
its, who had the courage and capacity to lead, 
Supported by a progressive public sentiment, 
and backed by a beneficent and able govern¬ 
ment, the greatest triumphs of sanitary science 
in the history of the world, have been recently 
witnessed, in the restoration of Cuba and Pan¬ 
ama from pestilence and death, and in the san¬ 
itary record of Japan in its war with Russia. 
As other evidences of the results of the appli¬ 
cation of modern knowledge of sanitary science, 
we turn to Italy and Greece. The former has 
been practically reclaimed from the cursed ef¬ 
fects of malaria. The latter, the intellectual 
decadence of whose people is said to have been 
probably due to malaria, is also being restored 
to its high place among the intellectual nations 
■of the world. 

The International Congress on Tuberculosis, 
just closed in Washington, was far and away 
in advance of any movement yet made in this 
country, toward demonstrating the extent and 
magnitude of the fight against tuberculosis, 
and how stupendous have been the results in 
some places, in decreasing the mortality rate 
from this scourge. The papers and discussions 
at the Congress, and exhibits were wonderful 
in their scope and variety, and will most surely 
•spur on to further action by individuals and 


10 


organized forces. The moving .and eloquent 
story told by some of the speakers was truly 
inspiring. Whether the question of the unity 
of the human and bovine bacilli was settled or 
not, the startling fact remains that, upon a fair 
estimate, there are in this country from 140,- 
000 to 160,000 deaths a year from tuberculosis, 
and that 5,000,000 of our people, according to 
Professor Fisher, of Yale University, are 
doomed to death by this disease, and that the 
cost, estimated in money, to the people is more 
than a billion dollars a year. Does not this 
demand the united efforts of the medical pro¬ 
fession, the public and the governments every¬ 
where ? 

Our own society should, at this session, in¬ 
augurate a movement for a general State Anti- 
Tuberculosis Association. This matter will 
probably be formally introduced for your con¬ 
sideration. 

INSANITY, ITS STUDY, PREVENTION, ETC. 

We have not yet attained that state of knowl¬ 
edge, and never will, when we can prescribe 
conditions which would absolutely insure brain 
health, yet we know enough to enable us to im¬ 
prove mental life, and prevent, to a great ex¬ 
tent, mental deterioration or destruction. The 
most valuable asset of mankind is a strong and 
healthy mind. It would therefore seem proper 
that we should arouse a discontent, with 


a view of encouraging inquiry into conditions 
unfavorable to sound mental health. 

The alienist and the metaphysician should 
no longer be left alone to work out the prob¬ 
lems of mental alienation. If the family phy¬ 
sician were more familiar with the early mani¬ 
festation of abnormal mind, many a homicide 
or other crime or suicide would be averted, and 
many cases of insanity prevented from going 
on to a chronic condition, or to incurable de¬ 
mentia. 

It cannot be overlooked that instruction in 
psychiatry has been inadequate so far as many 
of our medical schools are concerned. a The 
most urgent need of medical education in Amer¬ 
ica to-day,” says Dr. Welch, “is the Psycho¬ 
pathic Clinic, where medical students, and 
physicians as well, may benefit by instruction 
in psychiatry, and whose scientific research into 
the causes and cure of insanity may be carried 
out unceasingly.” 

The psychopathic ward, or hospital and 
clinic, is already a realization in many of the 
university towns of Europe, as well as in sev¬ 
eral states of this country. It is worthy of 
note, and should be of special interest to phy¬ 
sicians of this state, that there will soon be 
established in connection with the Johns Hop¬ 
kins Hospital a model psychiatric clinic, and 
a professorship in psychiatry, to meet the de¬ 
mands of modern, research and. teaching in this 


12 


much neglected branch of medical study. The 
selection of Dr. Adolf Meyer, alienist, patholo¬ 
gist, investigator and teacher, to inaugurate 
and develop this new move is sufficient guaran¬ 
tee of its success. 

The far-reaching practical importance of 
this matter is such that it cannot be much longer 
evaded in this State. Whether such an insti¬ 
tution as indicated should be developed in con¬ 
nection with a medical school, as part of the 
general hospital—in the form of properly 
equipped psychopathic wards,—as a distinct 
State institution, or as a special feature of the 
existing State hospital service, is a matter that 
requires careful consideration. The last seems 
to be the most feasible. 

There exists in the public mind much of the 
insoluble mysticism prevalent among our not 
very remote ancestors, who regarded insanity, 
and, in fact, diseases generally, as an inscrut¬ 
able visitation of Providence as punishment for 
misdeeds. The people should be given a better 
understanding of the real nature of insanity 
and educated out of traditional prejudice 
against the public hospital for the insane. 
There is still a wide-spread impression that the 
insane patient must remain at home until he 
is “ripe for the asylum,” that is, incurable, 
generally. “The asylum,” says Maudsley, “is 
too often regarded rather as a burying-ground 
for ruined minds than a hospital for the cure 


13 


of brain diseases.” Away with this cant about 
the stigma of s being adjudged insane. Better 
seek the early removal of what produces the 
stigma. Says Professor Clifford Allbutt: “The 
stigma, if such there be, lies in the misfortune 
itself, and not in the red tape of the proceed¬ 
ings.” Nevertheless, voluntary admission to 
hospitals has many decided advantages in cases 
of incipient insanity. 

There should be a united effort on the part 
of physicians and the intelligent laity to bring 
about that popular sentiment that would de¬ 
mand for our insane, epileptics and feeble¬ 
minded, the best care and treatment the finan¬ 
cial condition of the State could possibly afford. 

It is to prevention, however, rather than to 
cure that we must look to the diminution in 
insanity. Indeed psychiatry should play an 
important role in preventive medicine of the 
future. Heredity, improper training in child¬ 
hood, unhealthy environment and bad living 
methods, together with alcohol, certain consti¬ 
tutional diseases and the effects of vice, are re¬ 
sponsible for a large proportion’ of the cases of 
insanity and mental defect. 

As a predisposing cause, heredity can be 
traced to between twenty and fifty per cent, of 
cases. “The fathers have eaten sour grapes 
and the children’s teeth are set on edge,” is a 
doctrine that cannot be ignored. As Dr. Henry 
M. Hurd, a distinguished alienist, tells us: 


14 


“The knowledge should become universal that 
every individual represents the sum total of the 
vices and virtues, faults and perfections, 
strength and weaknesses of his remote ances¬ 
tors, plus special morbid conditions or other¬ 
wise, which existed among his immediate pro¬ 
genitors.^ 

The first step, then, in our efforts to reduce 
insanity and mental defectiveness, is by their 
non-production. Should state medicine longer 
withhold its influence from this great problem 
of adopting rational principles of natural 
and sexual selection in the # propagation of 
our species ? “Should not the State take cog¬ 
nizance of these things, which are more insid¬ 
ious and equally, if not more destructive or 
damaging to the race, than all infectious di¬ 
seases combined ?” Let physicians in their 
professional capacity teach parents and child¬ 
ren of the almost certain mental, or physical, 
or moral degeneracy in the offspring resulting 
from the union of two stocks already tainted 
with insanity, epilepsy, alcoholism, certain 
constitutional and other transmissible degener¬ 
ating diseases and defects. Let the State en¬ 
act prohibitive laws, with the view of protect¬ 
ing the race from disastrous diseases and in¬ 
validism. 

While heredity is important as a predispos¬ 
ing etiological factor, it is not necessarily true 
that the offspring of the insane, the epileptic or 


15 


the mentally defective &re bound to follow 
in the footsteps of their diseased parents or 
grandparents. In a very large measure this 
tendency can be controlled by the individual. 
Proper living, healthy environment, personal 
hygienic habits, nourishing food, attention to 
bodily functions, abundance of fresh air and 
sunlight, sufficient rest, sleep and physical ex¬ 
ercise, mental recreation, and avoidance of pro¬ 
longed overwork and stress, will usually out¬ 
weigh even the direful effects of a bad heredity. 
Our brains are, after all, largely what we make 
them. 

Heed I call attention to the significance of 
alcoholism in its relation to insanity and 
degenerative processes of the organ of mind, 
either as cause or effect ? This is a question 
which belongs largely in the province of scien¬ 
tific medicine. The pernicious influence that 
alcohol, opium and cocaine exercise on the 
physical, intellectual and moral spheres of life, 
cannot be controverted. A further, more thor¬ 
ough and impartial examination should be made 
regarding the alcohol question, and then the 
public should be given, in the plainest possible 
terms, definite answer to this most perplexing 
question: What real part does alcohol play as a 
medicine, as a poison, as a food, as a narcotic 
and motor depressant, or other effect, or as a 
deterent to the development of the race % 

From a practical and from a scientific stand- 


10 


point as well, it would, at least, seem that the 
confirmed inebriate is a proper subject for con¬ 
trol and medical treatment, both for the good of 
himself and that of his family and the com¬ 
munity. He should be committed to an insti¬ 
tution of the farm-colony type in which his 
remaining abilities could be utilized to some 
good purposes. Many cases' could thus be 
restored to useful citizenship. 

As a prophylactic, as well as humane, meas¬ 
ure, there needs to be a more careful medical 
study of the sojourners in our reformatories 
and prisons. Many of these are moral delin¬ 
quents, or mental degenerates, many inebriates, 
some actually insane. It would be better for 
the community and the future of our race if 
many of these, especially the habitual criminal, 
who are now sent from the prisons, were per¬ 
manently segregated. We may confidently look 
to the State Board of Charities and Correction, 
recently established in this State, for valuable 
suggestion along this line of work. An excel¬ 
lent provision in the law creating this new de¬ 
partment is that requiring that a physician—a' 
member of the local board of health—be on the 
local auxiliary board of. inspectors of jails, 
and almshouses. 

SUICIDE. 

Suicide is another difficult problem confront¬ 
ing both the laity and the medical profession, 
which in recent years has rapidly assumed 


17 


omi irons proportions. In a recent maga¬ 
zine article, from an authoritative source, it 
was stated that, in 1881, the total number of 
suicides in this country was 605, or, at the rate 
of 12 per 1,000,000 of the population. Last 
year the number had risen to 10,782, or at the 
rate of 126 per 1,000,000 of the population. 
During the past eighteen years 120,000 sui¬ 
cides have been reported in this country. 

.No satisfactory theory as to the causes of 
this great increase has been given. But doubt¬ 
less much depends upon these factors: Faulty 
early education and training, a bad hered¬ 
ity, effects of excessive use of alcohol and nar¬ 
cotic drugs, over-indulgence in the various dis¬ 
sipations of the limes, stress and anxiety inci¬ 
dent to the rush after wealth and worldly suc¬ 
cess, a moral cowardice and an unwillingness 
to carry an extra share of burden, apparent or 
real. 

A study of the causes of suicide often re¬ 
veals a pre-existing brain disturbance, which 
culminates in an overpowering morbid impulse 
to “shuffle off this mortal coil,* yet in many 
cases, there has been no ascertainable morbid 
predisposition, or other evidences of an un¬ 
balanced mind. Occasionally one guilty of a 
capital offense or otherwise transgressing the 
law, may probably resort to suicide rather than 
face the inevitable consequences of crime. 

It has been claimed, and, with good rea- 


18 


soning, that the influence of suggestion, due 
to the reading of details of suicide, published 
in the newspapers, is an important etiological 
factor. Certainly the imitative element has 
often been observed in persons mentally weak. 
An attempt at suicide by one patient in a hos¬ 
pital for the insane is usually followed by sim¬ 
ilar attempts by other patients. 

EXPERT TESTIMONY. 

My time is too limited to admit of more 
than a brief mention of another important sub¬ 
ject which has of late been so much in the pub¬ 
lic mind: Insanity as a defense in criminal 
cases. The impression seems to be generally 
prevalent that all insanity experts are “for 
hire” to the “highest bidder.” This is a gross 
injustice to those alienists who are capable and 
honest. That there are dishonest medical wit¬ 
nesses, as there are shyster lawyers and corrupt 
jurors, no one will deny; but should the entire 
company be judged by one unprincipled fel¬ 
low? People who know absolutely nothing 
about insanity or the intricate workings of 
man’s mind, normal or abnormal, are ready to 
join in the wholesale criticism of the opinion 
of any and all experts. Often the opinion of 
a competent alienist is essential to truth and 
justice. Unfortunately, we sometimes see in 
the witness chair unscrupulous fellows, posing 
as experts—men whose only purpose is to get 
a fee or to aid the lawyer in winning the case 


19 

for “their side,” regardless of the scienti fi(* 
truth, or, else men whose lack of training or 
experience unqualifies them for the important 
role which they assume. 

Every precaution should be exercised to pre¬ 
vent the insanity plea from being abused, and 
thereby giving the real criminal undeserved 
protection. Nevertheless,.it is entirely in line 
.of modern progress in forensic medical to have 
every one charged with crime, in which there 
is reasonable doubt about his mental condition, 
examined by fair and competent experts. 

This matter is of such vital importance, that 
our laws and practices should be amended, so 
as to put it in the power of, and make it the 
duty of, the court to name the experts instead 
of . having them selected by the defense, or 
the prosecution. The witnesses thus called 
should, of course, be subjected to cross- exam¬ 
ination by both sides in the case. This 
would at least prevent the possibility of the 
expert being partisan, which he should never 
be. Another plan which appeals to me, is 
to have the court appoint a commission of 
experts whose duty it would be to examine 
and study the case in question and report 
its opinion to the court. Thei report should be 
open to both the prosecution and the defense 
and, if desired, used in evidence. A correct 
solution would in this way usually be quickly 
reached. 


20 


In at least two or three states it has been 
recommended that the organized medical asso¬ 
ciations furnish the courts a list of names of 
members of the profession, from which an ex¬ 
pert, or experts may be selected, as required. 
The expert should always be paid out of the 
public treasury, and his compensation should 
he a fair one. At all events, I trust that 
this Society and the Virginia Bar Association 
will take up this matter jointly and recom¬ 
mend to the legislature a hill looking to the so¬ 
lution of this difficult problem. 

PROTECTION OF CHILDREN'S HEALTH. 

An important causative factor in the increase 
of nervousness and insanity is to be found in 
our faulty educational methods. The subject 
of .overwork of school children at a tender age, 
and often under unhygienic condition both 
in respect to person and evironment, and during 
the critical period of puberty and adolescence, 
is a serious one. It calls for the most careful 
consideration by the medical profession. Par¬ 
ents and teachers should be warned against the 
everlasting strain under which young children 
are constantly laboring to keep up with the 
prescribed course of study in our schools; par¬ 
ticularly those children whose health is already 
in jeopardy from unfavorable heredity. 

One of the greatest needs of the hour is a 
more extensive and systematic medical exami¬ 
nation of all school children, especially those 


21 


who show any evidence of physical or mental 
weakness or defect. Instead of the irregular, 
haphazard methods that usually prevail—each 
city or county doing the work in its own way 
and in its own time—there should he a well- 
organized authoritative power to direct intelli¬ 
gent efforts towards definite ends. Many cases 
of insanity and nervous breakdown in adult life 
can be traced directly to the school room. 
City and county school boards would do well 
to have medical members, whose advice and 
suggestions in sanitary and hygienic matters, 
and in the physical and mental condition of 
the pupils, would be of inestimable value. 

There is a class of children for which I make 
a special plea. It is the really feeble-minded. 
The well-to-do may employ trained teachers, 
or send their mentally defective children to 
special schools. The less fortunate poor hav¬ 
ing no such advantage, their mentally deficient 
children have to remain at home, untaught and 
neglected, to grow up in intellectual darkness, 
doomed to a life of inutility. 

Both as humanitarians and scientists, physi¬ 
cians should unite with the intelligent non¬ 
professional public, in urging suitable instruc¬ 
tion for the mentally abnormal children, in 
separate classes, auxiliary schools attached to 
the ordinary schools, or, perhaps, in special 
institutions.' Such children “don’t know where 
they are going,” but, we know, that they are 


on their way”—to hopeless degeneracy, or to 
become objects of public care. It is a duty we 
owe the rising and future generations to develop 
the physical as well as the intellectual and the 
moral attributes of children. The responsi¬ 
bility of furnishing for the future a vigorous, 
brainy, high-minded and moral manhood and 
womanhood cannot be shirked by those of this 
generation. 

EDUCATION OF THE PUBLIC IN MEDICINE* 

Educated and trained in the science and art 
of medicine, qualified to appreciate the causes 
of disease and the means of prevention, the 
physician owes it to himself, his profession and 
the State, to educate public opinion in the direc¬ 
tion of the promotion and the development of 
means for relieving human suffering. It is his 
paramount duty to teach the people in matters 
pertaining to the preservation of their health, 
in order that they may be happy and useful 
citizens. 

Dr. Joseph D. Bryant, recently President 
of the American Medical Association, enun¬ 
ciates a sound doctrine in these words: “Those 
physicians who regard the practice of medicine 
as a business enterprise should class them¬ 
selves as brokers in a market of human af¬ 
fliction.” The profession of medicine is es¬ 
sentially altruistic in character. Yet, there is 
no reason that the physician should not apply 
conservative business principles in the conduct 


of his practice, and have a proper estimate of 
the value of his professional services. The peo¬ 
ple should learn to discriminate between the 
value of the service of a high-grade, competent 
doctor and that of the “cheap commodity.” 

The public should be given, as far as prac¬ 
ticable, a proper understanding of our work 
and our progress, our purposes and our aims; 
of their needs and our ability to supply them. 
We owe it to the great science we represent, 
to be frank and open in all our dealings with 
others, carrying always a cheerful spirit. As 
Dr. William S. Thayer says: “The physician 
has no higher public duties than the duty of 
simplicity, the duty of the avoidance of mys¬ 
tery in medicine, and the duty of truthfulness. 
Towards his patients I know of no more vital 
duty than the duty of optimism.” There must 
he, however, a responsive and intelligent co¬ 
operation between the people and the medical 
profession. It is in this way only that we 
gather strength to direct and carry into success¬ 
ful operation measures for the betterment of 
the health of the people. 

In his inaugural address before the American 
Medical Association this year, Dr. Herbert L. 
Burrell exphasized the following agencies by 
which the public should be educated in medi¬ 
cine: First, judiciously edited newspaper arti¬ 
cles, authorized by a responsible board of med¬ 
ical men; second, magazine articles written by 


skilled lay writers, inspired by medical men 
of sound knowledge and discretion; third, free 
public lectures by men who are authorities in 
their subjects; fourth, individual 'teaching by 
the family physician. The last, he regards, as 
the most potent agency of all. 

MEDICAL LEGISLATION. 

It is a solemn duty of physicians to take a 
special interest, yes, take the initiative, in 
medical legislation. They should fearlessly ad¬ 
vocate needed reforms and point the way to the 
creation of the necessary agencies having for 
their aims the prevention and the cure of dis¬ 
ease and the advance of medical science. 
Legislatures, being composed largely of men 
untrained in the consideration of such sub¬ 
jects, need to be frankly and intelligently in¬ 
formed by competent physicians. While we 
have not always impressed the law-makers suffi¬ 
ciently to get through all the legislation we de¬ 
sire, we have, nevertheless, succeeded to a meas¬ 
urable degree. Let us not lose patience or be¬ 
come discouraged, but, with a strong will and a 
united force, continue our efforts. Be earnest 
and active. The loss of many a good cause has 
been due to disastrous inactivity. 

I have found that the Virginia legislators 
have been, with comparatively few exceptions, 
gentlemen whose aims were for the welfare of 
the community. It is seldom that men in po¬ 
litical or public life are not influenced by sound 


25 


argument and open to* conviction, certainly 
when approached in a tactful, judicious manner 
by an earnest, conscientious advocate. Some 
one has truthfully said that “the vehemence 
which we are too apt to display only excite the 
sensitiveness of the legislator—and when 
passion enters in, reason passes out of the 
door.” 

In order that we may go before the legis¬ 
lature of 1910 with the strongest possible back¬ 
ing and show of success, I would suggest that, 
at this session of our society, the incoming 
president appoint special committees, whose 
duty it shall be to co-operate with and aid our 
legislative committee in studying the situation 
and the apparent needs and getting into line for 
good work. At our next session we should an¬ 
alyze the recommendations of such committees, 
and give united support to whatever, in the 
judgment of the society, may seem proper. And 
then bills should be properly drawn and pre¬ 
sented early in the session. 

The subjects which seem to me to be worthy 
of such consideration are: 

1. The physician’s license tax, a matter 
about which we have already spoken in no un¬ 
certain tone. 

2. Amendments to the medical practice acts ; 
adequate protection of a credulous public 
against the pernicious practice of quack 
fleecers. 


26 


3. Prevention of the manufacture and sale 
of impure, adulterated drugs, and the regula¬ 
tion of the “patent” and proprietary medicine 
business. 

4. Further restriction of the selling or dis¬ 
tribution of cocaine and opium or “remedies” 
containing them, or other poisonous drugs. 

5. Further improvement in laws relating to 
public health organizations; the systematic reg¬ 
istration of all births and deaths; increase of 
the funds to be expended by the State Board 
of Health in the excellent work already begun. 

6. The establishment of sanitoria for con¬ 
sumptives; institutions for the feeble minded; 
colonies for epileptics, and probably inebriates. 

7. Uniform medical examination of school 
children; the teaching and the practical ap¬ 
plication of school hygiene; special schools 
or classes for the teaching of backward child¬ 
ren. 

8. Statutory prohibition or regulation of 
the marriage of the unfit, the imbecile, and 
other defectives. 

9. Revision of laws regulating expert testi¬ 
mony, and examination and commitment of 
and special provision for the criminal insane. 

If nothing else were accomplished, we would 
gain from study and investigation a far more 
comprehensive understanding of these subjects 
than we now have, which would lead to concert 
of action, and place us upon a higher plane. 


27 


MEDICAL ORGANIZATION. 

The most profitable attainment of the medi¬ 
cal profession, both as regards its own progress 
and welfare, and its usefulness and influence 
in the community, is a broad-gauged, strong 
organization. The fundamental objects of a 
medical society should be to encourage profes¬ 
sional attainments, to “inculcate a high sense 
of professional honor/’ and a proper apprecia¬ 
tion of ethical conduct, and to cultivate good 
fellowship and professional brotherhood. 

Safeguarded by pure personal character, and 
the “highest motives of professional purposes 
and of public welfare,” we can keep ourselves 
immune from even suspicion of questionable 
conduct or of selfish and commercial purposes. 

Organized nearly forty years ago by ninety- 
eight progressive, public-spirited doctors, the 
Medical Society of Virginia has grown, till 
now the membership roll has reached about 
1,500. There are only a few reputable phys¬ 
icians in the State who are not connected with 
the association. Its potential and uplifting in¬ 
fluence has been largely instrumental in bring¬ 
ing up to its present height the standard of 
medical qualification in the State, the eleva¬ 
tion of medical knowledge, and in pressing on 
to higher professional ideals and accomplish¬ 
ments, and in creating more general public 
confidence in the science and art of medicine. 

Each county and city of the State should 


28 


have a local organization which should be in 
affiliation with the parent Society. There are 
now only thirty-five city, county and district 
medical societies in the State. There should 
be many more. There should be co-operation 
and co-ordination of all our forces. Individu¬ 
als and organizations should unite in earnest 
efforts for the upbuilding of the profession 
everywhere. 

Some day we should commemorate in a fif¬ 
ing manner the work of those pioneers in med¬ 
ical organization in this State, nearly all of 
whom have gone to their reward. But, my col¬ 
leagues, 

"God be thanked that the dead have left still 
Good undone for the living to do— 

Still some aim for the heart and the will 
And the soul of a man to pursue.” 

With this session our new or revised Consti¬ 
tution and By-Laws go actively into operation. 
Let us, gentlemen, give our “new instrument” a 
fair test, and then, as occasion arises, make such 
alterations as may seem desirable to serve the 
best interest of the Society and the profession 
of the State. Changes were made with the view 
that the affairs', of the Society may be conduct¬ 
ed more nearly in accordance with the modern 
methodical way prevailing in similar organiza¬ 
tions; that, by a more widespread representa¬ 
tion in the official management, more personal 


29 


interest would be manifested; and that, by a 
large representative committee, the Executive 
Council, composed of sixteen members from dif¬ 
ferent sections of the State, putting into proper 
shape all business matters before they are sub¬ 
mitted for final action by the Society, and the 
nomination to the Society of officers and com¬ 
mittees, more time would be had for scientific 
papers and discussions. 

Perhaps there should be some amendments 
to the new constitution and by-laws. Unless, 
though, their adoption be urgent, it seems to 
me that it would be the part of wisdom to re¬ 
fer all such propositions to the Execu¬ 
tive Council, with instructions to thoroughly 
investigate and report recommendations at our 
next annual session. This would give ample 
time for reflection by every member of the So¬ 
ciety, many of whom cannot attend this ses¬ 
sion. 

The matters that should probably be consid¬ 
ered are: 

1. The publication of the entire transactions, 
including papers, etc., in bound volume. Wheth¬ 
er the large amount annually expended for this 
purpose is justifiable, and whether the greater 
part of the matter usually published is of prac¬ 
tical value, are questions that should be care¬ 
fully looked into. 

2. The permanency of a place or places of 
the annual sessions in the larger cities ; the 


establishment of a fixed home, and a library. 
It is time that we were collecting and storing 
away in some systematic method the writings 
of our own physicians and surgeons, and also 
establishing a circulating and referense library. 

3. The division of the Society, at annual 
sessions, into sections, probably medical and 
surgical, in order to get through with the pro¬ 
gram of papers in a satisfactory manner. 

4. The establishment of a fund to be used 
in the encouragement of original research, and 
probably efforts along other lines in the direc¬ 
tion of the uplift of the science of medicine. 

5. The question of the finances of the So¬ 
ciety also needs to be considered, and, if prac¬ 
ticable, some plan devised by which the ever¬ 
lasting stringency in our treasury department 
may be relieved. 

In the words of an eminent physician, “De* 
spite the fact that we are all human, and pos¬ 
sess our fair share of human frailties, we are, 
with singularly few exceptions, all working 
earnestly, as best we can, in the search of truth 
and for the good of humanity.” 

Let us continue to work onward and upward, 
striving ever to add to what we have already 
accomplished, for “every day and all day long 
the process goes on, a death of error, a devel¬ 
opment of truth.” Take hope, for, in the words 
of a great statesman, “we are rising steadily to 
plains higher than we have yet known.” 


31 


Each of us is needed in the firing line. Be 
not only urgers of reforms wherever needed, 
but doers of the work. Let us not only create 
a “storm of current which clears the atmos¬ 
phere. but he the trade wind which carries to 
port the freighted ship of a people’s hope.” 









































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